Medicare Part B – Medical Insurance

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Medicare Part B covers two types of services, medically necessary services and preventive services. Medically necessary services include services or supplies that are required to treat or diagnose a medical condition.

Preventive Services include health care services to prevent an illness or to detect and treat an illness in the early stages.

Medicare Part B – Medical Insurance

Medicare medical insurance Part B is part of Original Medicare. It will cover 80% of the Medicare approved amount for certain medical services and treatments.

Below will discuss what it covers, the different out of pocket costs, when to enroll and how to apply.

What Does Medicare Part B Cover?

Medicare Part B coverage includes benefits for a medically necessary treatment for an injury, illness or health condition.

It also covers certain types of preventive care. Medicare medical insurance helps pay for:

  • Doctor visits, including specialists, an annual physical and a second opinion before surgery
  • Lab tests
  • Tests such as X-rays, MRIs, CT Scans and EKGs
  • Outpatient surgery
  • Emergency room visits, including an ambulance if needed
  • Some diagnostic tests, like mammograms and colonoscopies
  • Medical equipment needed at home, like walkers and oxygen
  • Mental health treatment
  • Flu shots

Part B covers most of your medical expenses, but it does not provide dental or vision benefits.

It also does not cover custodial care, such as help with bathing and dressing or the cost of an assisted living facility.

Medicare Part B Benefits Chart 2019

wdt_ID Service Benefit Medicare Pays You Pay
1 Medical Expenses Physicians services, inpatient and outpatient medical services and supplies, physical and speech therapy, diagnostic tests, and durable medical equipment 80% of approved amount (after $185 deductible); 100% for clinical laboratory services; (certain limits may apply for physical, speech and occupational therapy) $185 deductible plus 20% of the balance of the Medicare approved amount
2 Home HealthCare (Including skilled nursing care, home health aide services, etc.) Unlimited as long as you meet Medicare requirements 100% of approved amount for services; 80% of approved amount for durable medical equipment Nothing for services; 20% of approved amount for durable medical equipment
3 Outpatient Hospital Treatment Unlimited treatment as medically necessary 100% after coinsurance or copay amount A coinsurance or copay amount, which may vary according to the service
4 Blood Unlimited during a benefit period if medically necessary 80% of approved amount (after first 3 pints and $185 deductible) $185 deductible plus 20% of the balance of the Medicare approved amount
5 Preventive Services Healthcare to prevent illness or detect illness at an early stage, when treatment is likely to work best including the "Welcome to Medicare" preventive visit and yearly "Wellness" visit. Preventive services include Pap tests, flu shots, and screening mammograms. 100% of coinsurance or copay amount Nothing for covered services. However, if your doctor or other healthcare provider performs additional tests or services during the same visit that are not covered under the same preventive benefits, you may have to pay coinsurance (20%) and the $185 deductible may apply.
wdt_ID Footnotes
1 Once you pay the $183 of expense for covered services in 2017, the Part B deductible does not apply to any further covered services you receive the rest of the year. Also, if your physician does not accept Medicare assignment, he/she may not bill you for more than 15% over Medicare's approved amount.

What is the Cost of Medicare Part B?

The cost of Medicare Part B includes a monthly premium, deductible and coinsurance. If you receive Social Security, your Medicare Part B premium will be deducted from your monthly check.

The standard Medicare medical insurance Part B premium is listed in the benefits chart above, but most people pay a little less than that.

Like most health insurance, Part B has a deductible, which is also provided in the chart above. After you have met your Medicare Part B deductible, Medicare pays 80 percent of the Medicare-approved cost of your medical expenses.

In most states, if your doctor accepts Medicare but doesn’t think Medicare pays enough for a service, the doctor can add an extra 15 percent to the Medicare rate – and you are responsible for paying these “excess charges.”

To help with these out of pocket costs, many Medicare recipients enroll in a Medicare Supplement, or “Medigap” plan. Medigap plans pay most, if not all, of your Medicare Part B costs that are left up the beneficiary to pay.

Once your Part B Medicare insurance is effective, you’ll have 6 months to enroll in a supplement plan. If you’ve missed this time period, you can still enroll, but you may have to go through the medical underwriting process.

To compare rates in your area on the different types of Medicare plans, fill out the form on the right now.

When Should I Enroll in Medicare Part B?

Some people are automatically enrolled in both parts of Medicare. If you weren’t automatically enrolled, Medicare Part B enrollment includes a seven-month Initial Enrollment Period that begins three months before the month you turn 65, the month of your birthday and ends three months after.

If you or your spouse is still working when you turn 65, and you’re covered under an employer health insurance plan, you don’t have to sign up for Part B right away.

You qualify for a Medicare Special Enrollment Period for Part B that allows you to enroll, penalty-free, around the time your employer coverage ends.

If you don’t qualify for a SEP and didn’t sign up when you turned 65, you can still enroll in Part B during the General Enrollment Period from January 1st to March 31st each year.

However, you’ll probably pay a late enrollment penalty – a higher premium for the entire time you have Part B — and your coverage will not take effect until July 1st.

Does Medicare Part B Cover Prescriptions?

Medicare Part B does not usually cover prescription medications administered at home. Normally, medications covered under Part B are given at a doctors office or hospital. Any medications not covered under your Part B may be covered under Part D.

Drugs Part B does Cover

  • Medications administered using durable medical equipment.
  • Certain types of antigens
  • Injectable osteoporosis medications
  • Oral End State Renal Disease medications
  • Blood clotting factors
  • Erythropoiesis stimulating agents

How to Apply for Medicare Part B

Those receiving Railroad Retirement benefits or benefits from Social Security, are in most cases, automatically enrolled. There are a few different types of situations that can apply to you if you weren’t automatically enrolled.

For more information on how to apply for Medicare Part B, click here.

Medicare Resources for Seniors

At MedicareFAQ, we help you understand your Medicare options and choose the best and most cost effective coverage. When you contact us for a free quote, we will search dozens of top rated insurers to find the best policy for you.

We pride ourselves in providing tons of Medicare resources for seniors, that’s why we’re always updating our FAQs with the most recent questions we’re asked about from our clients.

Our agents have helped many seniors, such as yourself, find a supplement plan that was within their budget and fit their healthcare needs.

If you’re ready to supplement your Original Medicare and cover the gaps to reduce and/or eliminate your out-of-pocket costs,  give us a call or fill out our online rate form now to get started!